Ultrasonography in the diagnosis of pediatric distal forearm fracture: a systematic review.

Purpose: Distal forearm fractures are one of the commonest injuries in children due to falling on an outstretched hand. Plain X-ray is the gold standard test for diagnosing fractures of long bones but it exposes patients to radiation with its associated health hazards. The use of ultrasonography has been proposed as a safer diagnostic test. This review aimed to summarize the evidence regarding the diagnostic accuracy of bedside ultrasonography for identifying distal forearm fractures in pediatric patients.

Methods: Electronic search of MEDLINE, EMBASE, Cochrane Library, Google Scholar, and Best Bets databases was conducted for studies published from inception to May 2017. The search terms used included "forearm" and "fractures" and "children."

Results: Seven studies were included in the review. The overall accuracy of ultrasonography ranged from 78.6% to 99.5%. The sensitivity and specificity ranged from 85% to 100%, and from 73% to 100%, respectively. The area under the curve for ultrasonography ranged from 0.79 to 1.00.

Conclusion: Ultrasound is a reliable diagnostic tool for the diagnosis of distal forearm fractures in children when performed by well-trained emergency doctors and through using an appropriate viewing method. Conducting larger prospective blinded studies on long bone injuries would be recommended.